Theodora Kanaki1, Andreas Stang2, Ralf Gutzmer3, Lisa Zimmer1, Eleftheria Chorti1, Antje Sucker1, Selma Ugurel1, Eva Hadaschik1, Nikolai S Gräger3, Imke Satzger3, Dirk Schadendorf1, Elisabeth Livingstone4. 1. Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. 2. Center of Clinical Epidemiology, C/o Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany. 3. Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School. 4. Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: elisabeth.livingstone@uk-essen.de.
Abstract
OBJECTIVE: The American Joint Committee on Cancer (AJCC) 8th staging system introduced several revisions. To assess the impact of the 8th edition American Joint Committee on Cancer (AJCC8) staging system on subgrouping and survival, patients with melanoma from two tertiary skin cancer centres were classified according to both the 7th edition American Joint Committee on Cancer (AJCC7) and AJCC8. METHODS: A total of 1948 patients aged ≥18 years with cutaneous melanoma stage II-IV were included. The impact of sex and age on reclassification was assessed by log binomial models. The inverse probability of censoring weighting method was used to compute ROC curves from time-to-event data to assess the discriminatory ability of AJCC7 and AJCC8. Melanoma-specific survival (MSS) and overall survival (OS) were calculated, and age- and sex-adjusted MSS hazard ratios were estimated using Cox proportional hazards models. RESULTS: Of all, 23.5% of patients were assigned a different subgroup when classified according to AJCC8. Owing to upshifting to stage IIIC (AJCC7 24.8% vs. AJCC8 50.8%), patient numbers of stages IIIA and IIIB decreased from 28.7% to 16.2% and 46.5% to 28.3%. The prediction accuracy for AJCC7 and AJCC8 was comparable (integrated time-dependent area under the curve [AUC] of 0.75 and 0.74, respectively). Five-year MSS of IIB and IIC AJCC8 was poor and lower than that of IIIA AJCC8 (80%, 67% and 89%, respectively). Compared to results of the International Melanoma Database and Discovery Platform, 5-year MSS was 10-15% points lower for stages IIC, IIIB and IIIC. CONCLUSIONS: Upshifting affects primarily stage III subgroups, while effects in stage II are minor. Stage IIB/C (AJCC8) patients have 67-80% MSS and should be considered for adjuvant treatment, while in stage IIIA, the indication of adjuvant treatment is questionable.
OBJECTIVE: The American Joint Committee on Cancer (AJCC) 8th staging system introduced several revisions. To assess the impact of the 8th edition American Joint Committee on Cancer (AJCC8) staging system on subgrouping and survival, patients with melanoma from two tertiary skin cancer centres were classified according to both the 7th edition American Joint Committee on Cancer (AJCC7) and AJCC8. METHODS: A total of 1948 patients aged ≥18 years with cutaneous melanoma stage II-IV were included. The impact of sex and age on reclassification was assessed by log binomial models. The inverse probability of censoring weighting method was used to compute ROC curves from time-to-event data to assess the discriminatory ability of AJCC7 and AJCC8. Melanoma-specific survival (MSS) and overall survival (OS) were calculated, and age- and sex-adjusted MSS hazard ratios were estimated using Cox proportional hazards models. RESULTS: Of all, 23.5% of patients were assigned a different subgroup when classified according to AJCC8. Owing to upshifting to stage IIIC (AJCC7 24.8% vs. AJCC8 50.8%), patient numbers of stages IIIA and IIIB decreased from 28.7% to 16.2% and 46.5% to 28.3%. The prediction accuracy for AJCC7 and AJCC8 was comparable (integrated time-dependent area under the curve [AUC] of 0.75 and 0.74, respectively). Five-year MSS of IIB and IIC AJCC8 was poor and lower than that of IIIA AJCC8 (80%, 67% and 89%, respectively). Compared to results of the International Melanoma Database and Discovery Platform, 5-year MSS was 10-15% points lower for stages IIC, IIIB and IIIC. CONCLUSIONS: Upshifting affects primarily stage III subgroups, while effects in stage II are minor. Stage IIB/C (AJCC8) patients have 67-80% MSS and should be considered for adjuvant treatment, while in stage IIIA, the indication of adjuvant treatment is questionable.
Authors: Matthew C Hynes; Paul Nguyen; Patti A Groome; Yuka Asai; Meaghan E Mavor; Tara D Baetz; Timothy P Hanna Journal: BMC Cancer Date: 2022-07-01 Impact factor: 4.638
Authors: Claus Garbe; Ulrike Keim; Stefan Suciu; Teresa Amaral; Thomas K Eigentler; Anja Gesierich; Axel Hauschild; Lucie Heinzerling; Felix Kiecker; Dirk Schadendorf; Rudolf Stadler; Cord Sunderkötter; Thomas Tüting; Jochen Utikal; Uwe Wollina; Christos C Zouboulis; Ulrich Keilholz; Alessandro Testori; Peter Martus; Ulrike Leiter; Alexander M M Eggermont Journal: J Clin Oncol Date: 2020-06-12 Impact factor: 44.544